Cost‐utility analysis of direct ventricular assist device vs double bridges to heart transplantation in patients with refractory heart failure

Chang, Hsiao-Huang; Chen, Po‐Lin; Chen, I‐Ming; Kuo, Tai Chih; Weng, Zen-Chung; Huang, Pei-Jung; Wu, Nai-Yuan; Cheng, Ching‐Li

doi:10.1111/ctr.13124

Cited by 7 publications

(4 citation statements)

References 22 publications

(28 reference statements)

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“…Although the cost of DAAs is perceived as a barrier for some transplant centers, 41 a 4-wk DAA regimen would comprise just 1.3% of the costs incurred by recipients in the month of a transplant if SQ + HCV were brought to scale. The additional per-person costs and resulting ICER of the SQ + HCV intervention fall well within the range of revealed willingness-to-pay thresholds of implemented healthcare interventions for heart failure patients (range: $24 920–$209 400/QALY), 28,39,40 and transplanting other HCV+ and high-risk organs (range: $56 000–$91 700/QALY). 13,42-44…”

Section: Discussionmentioning

confidence: 62%

“…These are substantial gains in terms of medical interventions for chronically ill patients 38 and are of the same magnitude as projected QALYs gained from other funded medical interventions for heart failure patients (eg, direct VAD as a bridge to transplant and adjunctive ivabradine therapy for heart failure patients with reduced ejection fraction). 39,40 The smallest gain in QALYs with SQ + HCV was projected for emergent candidates because their waitlist time is already short.…”

Section: Discussionmentioning

confidence: 99%

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The Cost-effectiveness of Transplanting Hearts From Hepatitis C-infected Donors Into Uninfected Recipients

et al. 2022

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Background. The DONATE HCV trial demonstrated the safety and efficacy of transplanting hearts from hepatitis C viremic (HCV+) donors. In this report, we examine the cost-effectiveness and impact of universal HCV+ heart donor eligibility in the United States on transplant waitlist time and life expectancy. Methods. We developed a microsimulation model to compare 2 waitlist strategies for heart transplant candidates in 2018: (1) status quo (SQ) and (2) SQ plus HCV+ donors (SQ + HCV). From the DONATE HCV trial and published national datasets, we modeled mean age (53 years), male sex (75%), probabilities of waitlist mortality (0.01-0.10/month) and transplant (0.03-0.21/month) stratified by medical urgency, and posttransplant mortality (0.003-0.052/month). We assumed a 23% increase in transplant volume with SQ + HCV compared with SQ. Costs (2018 United States dollar) included waitlist care

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

The Cost-effectiveness of Transplanting Hearts From Hepatitis C-infected Donors Into Uninfected Recipients

et al. 2022

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“…The whole cohort was entered into the models in the alive non-hospitalised state. We used a cycle length of one month, consistent with other published models specific to heart failure [14,15], and a 30-year horizon so as to ensure less than 1% of survivors.…”

Section: Model Population Treatment and Effectivenessmentioning

confidence: 99%

Conflicting findings between the Mitra-Fr and the Coapt trials: Implications regarding the cost-effectiveness of percutaneous repair for heart failure patients with severe secondary mitral regurgitation

et al. 2020

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Purpose Two randomized controlled trials (RCTs), Mitra-Fr and Coapt, evaluating the benefit of percutaneous repair (PR) for heart failure (HF) patients with severe mitral regurgitation, have led to conflicting results. We aimed to evaluate the impact of these trial results on the cost-effectiveness of PR using effectiveness inputs from the two RCTs. Methods We developed a time varying Markov type model with three mutually exclusive health states: alive without HF hospitalisation, alive with HF hospitalisation, and dead. Clinically plausible extrapolations beyond observed data were obtained by developing parametric modelling for overall survival and HF hospitalisations using published data from each trial. We adopted the perspective of the French Health System and used a 30-year time horizon. Results were expressed as € / quality-adjusted life year (QALY) gained using utility inputs from literature. Findings Results are presented using treatment efficacy measures from Mitra-F and Coapt trials respectively. With the Mitra-Fr data, after annual discounting, the base case model generated an incremental 0.00387 QALY at a cost of €25,010, yielding an incremental cost effectiveness ratio (ICER) of €6,467,032 / QALY. The model was sensitive to changes made to model inputs. There was no potential of PR being cost-effective. With the Coapt data, the model generated 1.19 QALY gain at a cost of €26,130 yielding an ICER of €21,918 / QALY and at a threshold of >€50,000/QALY PR had a probability of 1 of being cost-effective. Implications Cost effectiveness results were conflicting; reconciling differences between trials is a priority and could promote optimal cost effectiveness analyses and resource allocation.

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“…From a health insurance payer perspective, direct bridging to heart transplantation with a ventricular assist device appears to be more cost-effective than "double bridges" in patients with refractory heart failure [3]. Thus, the extracorporeal ventricular assist device (e-VAD) system is designed for left ventricular (LV) support with a simple circuit configuration using the permanent life support (PLS) system.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Extracorporeal Ventricular Assist Device for Cardiogenic Shock as a Bridge to Transplantation

Kim

Shin

Kim

et al. 2020

Korean J Thorac Cardiovasc Surg

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Background: The extracorporeal ventricular assist device (e-VAD) system is designed for left ventricular support using a permanent life support console. This study aimed to determine the impact of temporary e-VAD implantation bridging on posttransplant outcomes. Methods: We reviewed the clinical records of 6 patients with the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1, awaiting heart transplantation, who were provided with temporary e-VAD from 2018 to 2019. The circuit comprised a single centrifugal pump without an oxygenator. The e-VAD inflow cannula was inserted into the apex of the left ventricle, and the outflow cannula was positioned in the ascending aorta. The median follow-up duration was 8.4±6.9 months. Results: After e-VAD implantation, lactate dehydrogenase levels significantly decreased, and Sequential Organ Failure Assessment scores significantly improved. Bedside rehabilitation was possible in 5 patients. After a mean e-VAD support duration of 14.5±17.3 days, all patients were successfully bridged to transplantation. After transplantation, 5 patients survived for at least 6 months. Conclusion: e-VAD may reverse end-organ dysfunction and improve outcomes in INTER-MACS I heart transplant patients.

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Cost‐utility analysis of direct ventricular assist device vs double bridges to heart transplantation in patients with refractory heart failure

Abstract: From a health insurance payer perspective, direct VAD bridge to heart transplantation appeared to be more cost-effective than double bridges in patients with refractory heart failure.

Cited by 7 publications

References 22 publications

The Cost-effectiveness of Transplanting Hearts From Hepatitis C-infected Donors Into Uninfected Recipients

The Cost-effectiveness of Transplanting Hearts From Hepatitis C-infected Donors Into Uninfected Recipients

Conflicting findings between the Mitra-Fr and the Coapt trials: Implications regarding the cost-effectiveness of percutaneous repair for heart failure patients with severe secondary mitral regurgitation

Outcome of Extracorporeal Ventricular Assist Device for Cardiogenic Shock as a Bridge to Transplantation

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